Shocking Heart Deaths: Why They Happen

Screening for Sudden Cardiac Arrest Risk

Sudden cardiac arrest occurs without previous symptoms in some cases.

But sometimes, there are red flags. For example, Reggie Lewis fainted during a basketball game a few months before his death.

The American Heart Association recommends a 12-step screening for high school and college athletes. It includes a careful family and medical history and a physical exam. The assessment asks about chest pain on exertion, unexplained fainting, a family history of premature death from heart disease, and other relevant issues. The physical exam includes a check for heart murmurs, pulses, blood pressure, and physical signs of Marfan syndrome.

But the assessment isn't applauded across the board, and how to best identify patients at risk remains debatable. Not all doctors use the assessment -- or even know that it exists -- and there are various issues involved.

For example, the causes of sudden cardiac arrest in athletes are rare. It's challenging to find a needle in a haystack in the best of circumstances.

Also, some athletes may be reluctant to report symptoms, especially if they think it could affect their playing time, rank, or scholarship chances.

There's another issue on top of that. "Probably the screening isn't done as diligently as it could be," says Vincent Mosesso, MD, FACEP, medical director of the Sudden Cardiac Arrest Association and a University of Pittsburgh professor of emergency medicine.

The AHA guidelines don't include a routine electrocardiogram (EKG) or echocardiogram (ultrasound evaluation of the heart). The use of these tests to screen athletes prior to participation is controversial and adds significant cost. Opponents argue that there isn't enough evidence to support their effectiveness in screening, that these tests aren't cost-effective, and that they can lead to further unwarranted testing. They may also produce misleading results that bar many athletes unnecessarily. "The fact that they'll be left out is a very real problem," Lawless says.

But not everyone is waiting for these tests to get the official green light. In Maryland, Johns Hopkins offers a screening program for student athletes, aged 14 to 18. In addition to a medical questionnaire and physical exam, it includes an electrocardiogram to check the heart's electrical rhythm and to screen for long QT syndrome, and an echocardiogram to assess heart size and shape, pumping function, heart muscle thickness, and condition of the heart valves.

Despite the debate over screening techniques, it's important to catch problems early because treatment can reduce risk of sudden cardiac arrest. For example, young people who are at risk might need to avoid competitive sports, take beta blocker drugs to prevent the heart from beating too fast, or have surgery to implant a defibrillator that can shock their heart back into a normal electrical rhythm.